Client satisfaction with family planning services: a case study of five clinics in Uganda

Abstract

Uganda, like most developing countries has a population with a high fertility rate of7.2 children per woman in 1989. Attempts at reducing these levels began in 1957 with establishment of the Family Planning Association of Uganda (FPAU, 1994). This study examines the importance of the quality of services in enhancing client satisfaction, contraceptive acceptance and continuation. Data used in this study was drawn from primary and secondary sources. Primary data on client satisfaction, accessibility and clinic factors was gathered through 506 client exit interviews, and in-depth interviews (IDI) with 20 clinic dropouts. Secondary data sources used 1994 clinic records on all new clients during 1994. Descriptive statistics, were used to analyse the data. The study found that despite the fact that most women interviewed intended to use contraceptives for long periods of time, they do not in reality practice their contraceptive intentions. About 65% of women interviewed had used contraceptives for one year or less, while only about 5% had achieved a length of more than six years. When the length of contraceptive use was related to client satisfaction, it was found out that length of family planning (FP) was positively related to client satisfaction. Indicators of accessibility we1"ea~ associated with client satisfaction i.e. it was found that long distance to, and high cost of travel to F~nics was significantly associated with client dissatisfaction. Availability of methods, adequate counselling before the choice of a method, good and close client/provider dialogue, and adequate quality of information given to clients was associated with client satisfaction. Levels of discontinuation or dropouts from the study clinics was found to be quite high. Between 59% to 74% of clients coming for the very fist time to the clinics dropped out. A follow up of clinic dropouts through in-depth interviews revealed that client were primarily dissatisfied mainly due to the side effects of the contraceptives, and the high costs of travelling to the clinics.

This study recommends that a community based approach in the distribution of contraceptives be developed to increase accessibility of FP services especially in rural areas if contraceptive prevalence has to be increased, and if fertility is to be lowered. Since clinic factors significantly affect client satisfaction, the study recommends that choice of methods, adequate counseling services and good client/provider relationships be enhanced so as to improve client satisfaction.